Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Feb 2017
Initial Single-Center Technical Experience With the BrainPath System for Acute Intracerebral Hemorrhage Evacuation.
Surgical intervention has been proposed as a means of reducing the high morbidity and mortality associated with acute intracerebral hemorrhage (ICH), but many previously reported studies have failed to show a clinically significant benefit. Newer, minimally invasive approaches have shown some promise. ⋯ Evacuation of ICH using the BrainPath system is safe and technically effective. The volume of clot removed compares favorably with other published studies. Early improved clinical outcomes are suggested by improvement in Glasgow Coma Score and reduced 30-day mortality. Ongoing analysis is necessary to elucidate long-term clinical outcomes and the subsets of patients who are most likely to benefit from surgery.
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Oper Neurosurg (Hagerstown) · Feb 2017
Diagnostic and Interventional Optical Angioscopy in Ex Vivo Carotid Arteries.
Angioscopy - or endovascular endoscopy - is a catheter-based technique employing a flexible fiberoptic angioscope to directly visualize arterial lumen. Poor resolution and excessive stiffness of pre-existent angioscopes limited their use clinically. Recent advances resulted in novel fused optical fiber bundle angioscopes with improved flexibility and imaging resolution. Use of these devices in endovascular neurosurgery is still largely unexplored. ⋯ Fused optical fiber bundle angioscopes provide good-quality endoluminal images in human carotid arteries. Their use can feasibly assist in navigation of extracranial carotid arteries to inspect integrity of the arterial wall and identify atherosclerotic plaques and associated lesions vulnerable to thrombogenicity, allow placement of intravascular occlusion coils, and assess apposition of stents to vessel wall. Further in Vivo validation needs to be conducted along with additional research to improve image quality, flexibility, and size of angioscopes.
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Oper Neurosurg (Hagerstown) · Dec 2016
Anatomic Understanding of Vertical Hemispherotomy With Cadaveric Brains and Intraoperative Photographs.
Vertical hemispherotomy is performed in hemispheric epilepsy to disconnect commissural fibers, projecting fibers, and limbic system from the affected side of the brain with minimal parenchyma removal. However, anatomic understanding of this surgery is generally difficult. ⋯ A step-by-step procedure using cadaveric brains and intraoperative photographs provide a better anatomic understanding of vertical hemispherotomy.
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Oper Neurosurg (Hagerstown) · Sep 2016
Intraoperative Identification of a Normal Pituitary Gland and an Adenoma Using Near-Infrared Fluorescence Imaging and Low-Dose Indocyanine Green.
The intraoperative distinction between normal and abnormal pituitary tissue is crucial during pituitary adenoma surgery to obtain a complete tumor resection while preserving endocrine function. Near-infrared (NIR) fluorescence imaging is a technique to intraoperatively visualize tumors by using indocyanine green (ICG), a contrast agent allowing visualization of differences in tissue vascularization. Although NIR fluorescence imaging has been described in pituitary surgery, it has, in contrast to other surgical areas, never become widely used. ⋯ NIR fluorescence imaging can easily and safely be implemented in pituitary surgery. The timing of ICG administration is important for optimal results and warrants further study. It appears that injection of ICG can best be postponed until some part of the normal pituitary gland is identified. Subsequent repeated low-dose ICG administrations improved the distinction between adenoma and gland.
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Oper Neurosurg (Hagerstown) · Sep 2016
Anatomical Variations of the Anterior Clinoid Process: A Study of 597 Skull Base Computerized Tomography Scans.
The anterior clinoid process (ACP) is surrounded by a complex anatomy; variations include pneumatization and the formation of bone bridges with the middle and posterior clinoid, which complicate surgery. The key to avoiding microsurgical complications is a perfect understanding of this anatomy. ⋯ At least 1 variation in ACP anatomy was found in 38.7% of cases with this simple method. Thus, a preoperative computed tomography scan could improve surgical procedures that involve removal of the anterior clinoid process.